Severity of mumps disease is related to viral shedding in urine

Abstract

No: 1476 Presentation at ESCV 2015: Poster 1 Severity of mumps disease is related to viral shedding in urine S. Gouma1,∗, D. Gijselaar1, S. Hahne1, M. Koopmans2, R. van Binnendijk1 1 National Institute for Public Health and the Environment (RIVM), Netherlands 2 Erasmus MC, Netherlands Background: Mumps often starts with non-specific symptoms such as fever and is followed in the majority of cases by parotitis. Orchitis is the most common complication among males. Despite introduction of the measles, mumps, and rubella (MMR) vaccine in 1987, recently various mumps outbreaks occurred among vaccinatedpersons in several countries, including theNetherlands.Here, we studymumps virus shedding in urine in relation to clinical data, to investigateapossible correlationbetweensystemicmumpsvirus infection and severity of disease in both unvaccinated and twice MMR vaccinated mumps patients. Methods: We investigated shedding of mumps virus in urine from 379 laboratory confirmed caseswith 2MMR vaccinations and from 150 laboratory confirmed cases with no MMR vaccination. Data on parotitis side, orchitis and fever were available for a subset of these patients (n=359, n=265 and n=365, respectively). Data were compared using the chi-square test. Results: Mumps virus shedding in urine was detected in 64.7% of the unvaccinated patients and in 44.3% of the twice MMR vaccinatedpatients (p<0.001). Bilateral parotitis and orchitisweremore often reported in unvaccinatedmumps patients than in twiceMMR vaccinated patients (p<0.001 and p=0.040, respectively). Bilateral parotitis was reported in 54.1% of the MMR vaccinated patients who shed mumps virus in their urine, whereas only 27.3% of the vaccinated patients with no virus shedding in urine reported bilateral parotitis (p<0.001). In unvaccinated mumps patients, mumps virus shedding in urine was not significantly correlated with side of parotitis (p=0.374). Orchitis was reported in 23.5% of the vaccinated male patients who shed virus in their urine as compared with 1.9% of the males who did not shed virus in urine (p<0.001). Inunvaccinatedpatients, 46.7%of themaleswho shedmumpsvirus had orchitis versus 6.7% of the males with no mumps virus shedding in their urine (p=0.005). No significant correlation was found between fever and mumps virus shedding in urine, irrespective of vaccination status (p≥0.243). Conclusion: Twice MMR vaccinated mumps patients shed less oftenmumps virus in their urine and had less often bilateral parotitis or orchitis than unvaccinated patients. These findings indicate that although the vaccine does not protect against mumps virus infection,MMRvaccinationprovides to someextent clinical protection. Furthermore, bilateral parotitis and orchitis were associated with mumps virus shedding in urine, which suggests a correlation between spread of the virus through the body, resulting in viruria, and severity of symptoms. http://dx.doi.org/10.1016/j.jcv.2015.07.066